Psychiatric diagnoses have always been difficult to develop and to
implement. Primarily this is because as of yet (though things may be
changing soon) we have not had robust independent biomarkers to help us
validate them. For example: in the diagnosis of chest pain, a doctor can
use an EKG and blood tests to help determine if the patient’s symptoms are more
likely to be caused by a heart attack or not.
While psychiatric
diagnoses are built on some good validation criteria for the most part, some
are less well buttressed with this evidence than others, and for some, opinion,
economics or social influences have quite a measure of impact.
For example, a recent story in the National Post indicated that some
physicians in Alberta
were still making a psychiatric diagnosis of homosexuality. Not only does this
not make any sense (homosexuality is not a psychiatric diagnosis), but it is
offensive and simply wrong-headed.
Frankly, I could not follow the article, and did
not understand what the reporter was trying to say – was the problem due to a
billing code or was a doctor(s) using that as a diagnostic code (which makes no
sense as neither the current ICD-10 nor the DSM diagnostic criteria contain
that as a diagnosis)? Or is Alberta
simply so far behind that it is using a medical diagnostic system that is over
25 years out of date?
Whatever the real story here, it is time that
psychiatric diagnoses were demanded by the profession and public alike to be
more based on the best available science than on opinion, insurance payments or
public pressure. My goodness, if one of the current candidates wins the
GOP nomination in the USA
who knows what silliness will make its way into diagnostic codes.
--Stan
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